Plantar Fasciitis is a painful foot condition that is a common problem among athletes and individuals who are physically active. It is a condition that occurs in middle-age athletes, but can occur among all age groups. Plantar Fasciitis is often seen in recreational athletes, especially runners. Cases are also seen in individuals who are involved in prolonged physical activities. The plantar fascia is a band of thick connective tissue that stretches from the heel bone to the ball of the foot. This structure functions to maintain the integrity of the arch of the foot. The plantar fascia transmits weight across the foot when a person walks or runs.

Signs and Symptoms of Plantar Fasciitis

Swelling and point tenderness around the heel bone or along the arch of the foot.

Pain in the affected area may be the most severe when standing on your feet, getting out of bed first thing in the morning.

Pain in the affected area of the heel or arch decreases as the foot "loosens" up after being used, but pain often returns with prolonged standing or walking.

Home Treatment Tips for those experiencing Plantar Fasciitis:

Rest - Avoid the activity that caused the Plantar Fasciitis for a few days. Take a break from running, jogging, or prolonged standing or walking. Try some alternate forms of exercise like swimming or cycling to keep up your conditioning.

Use of Ice or Cold Therapy- The use of ice after activity, or after as acute episode of symptoms, will help in reducing the severity of symptoms. You can use an ice cup to perform an ice massage to the heel and arch of the foot. Take a small styrofoam or paper cup and fill it three-quarters full with water and place it in the freezer. Leave the cup to freeze overnight. When you are ready to perform the ice massage, peel back the edge of the cup to expose the ice, and rub the ice on the affected area using a circular motion. Another technique to ice an inflamed plantar fascia is to roll the affected foot on a frozen water bottle. Freeze a 1 or .5 liter bottle of water and place your foot on the bottle, rolling back and forth while applying pressure. Either technique can be used 15-20 minutes at a time. Be sure to let the area re-warm itself for at least 40 minutes before re-applying ice to the affected area.

Strengthening and Flexibility Exercises- These exercises are designed to help strengthen the muscles of the foot to assist in supporting the arch and withstand the repetitive stress placed upon them during activity. Also, flexibility exercises will help stretch and loosen the plantar fascia.

Toe Curls- Rest your foot on a towel outstretched on the floor. Place your toes at one end of the towel. Curling your toes, bunch the towel beneath your foot. You can place a small object (like a book or a large soup can) at the opposite end of the towel for added resistance.

Pick Up with Your Toes- Pick up objects, such as marbles, dice, nuts and bolts, with your toes and place them in a nearby container.

Single Leg Balance Exercises- Stand and balance with only your affected foot in the floor, and then progress to using an unstable surface. You can use a very firm pillow to create an unstable surface. For an added degree of difficulty, perform the exercise with your eyes closed.

Towel Stretch- Place a towel, or even a stretch band if one is available, around the toes. Pull on the towel towards yourself to slowly bend back the toes. Keep pulling until tension is felt in the arch of the foot.

Standing Calf Stretch- Stand on the edge of a step with the ball of your foot. Let your body weight allow your heels to drop below the level of the step until a stretch is felt in the arch and in your calf muscles as well.

Use of Anti-Inflammatory Medications- Using anti-inflammatory medications, such as NSAIDs, will help reduce inflammation and pain. Over-the-counter medications will work in most cases. Please consult your physician if you choose to pursue available options using prescription medication.

Shoe Inserts, Arch Supports, or Custom Orthotics- These additional supports will address the problem of a lack of arch support seen in standard soles found in shoes. This lack of support may lead to an increase in tension of the plantar fascia, which can lead to inflammation and injury to the area. These supports are important if one has a flat or a high arch. They will often help relieve symptoms and allow one to continue their normal activities with a minimal amount of discomfort.

If you are experiencing symptoms of Plantar Fasciitis, try these home treatment techniques at the first onset of symptoms. Try not to train through the pain, but try and address the problem as it first arises. Heel Spurs can develop as a complication of Plantar Fasciitis that has gone untreated. If symptoms persist or increase, please consult your physician, Podiatrist, or Orthopedic Specialist with experience in Athletic-Related injuries for further evaluation.

My wife's friend recommended that I read a book with the above title by Dr Paul Brand, and felt so strongly about it she sent us the book. The book is about Dr. Brand's experience working with individuals with various conditions such as leprosy, diabetes, and congenital nerve disorders that lead to the absence of pain. Upon reading the first couple of chapters, my view of pain had evolved from pain being a nuisance to pain being a healthy part of being alive.

I have always thought of pain as a negative, imperfect part of the human body. I used to think and imagine what I could be capable of if I did not feel pain. I took this philosophy to my professional life as well, focusing on pain management rather than the cause of the pain.

When the yellow or red check engine light goes on in your car, do you disconnect the dash board so the light goes off and keep driving? No, you research what caused the light to go on and get the problem fixed. It is no different with pain in the body. Pain is our check engine light, and if we ignore it, more serious problems will develop. It is very important we determine the cause of pain so that we can remedy the problem early on. Pain is a warning signal for things like lack of flexibility, training without enough recovery, improper training, muscle imbalance, poor form, etc.

One of the coolest things about being an Athletic Trainer at a college is we are available on campus during practices and competition to address these small problems that can lead to big problems later on. Sure, we treat the big problems as well, but we treat them in such a way that we address the underlying problem so we can prevent future injuries.

So, if you are having pain, don't think of the pain as a negative thing, think of the pain as a warning light. Then get go see a health care professional, such as an Athletic Trainer, to determine the nature of the problem and how to fix the problem so you can get back to doing the activities you enjoy most.

Is it wiser to numb away the pain of injury with ice or to melt the pain away with warmth? And in choosing one over the other – which is

the correct choice? Well, that depends, since all pain is not created equal.

_When Ice is Nice _

Traumatic injuries that occur immediately and cause a sudden onset of pain are known as acute injuries. Typically with injuries such as these, it's fairly obvious what the cause is – usually some form of impact, fall, sprain, or collision. These injuries can cause swelling, bruising, tenderness, pain, and skin that is warm to the touch. This acute phase starts at the time of injury and can

last up to four days, sometimes longer. During these four days ice is the best choice. Ice is also always the best choice post-workout.

When you put ice on an injured area, it decreases inflammation resulting in decreased pain, can stop muscle spasm, and it decreases blood flow which can slow the bleeding in the tissues. If you were to put heat on an acute injury, this may cause increased

inflammation and increased pain.

Application: Usually, you want to ice for about 15-20 minutes to give the ice time to penetrate to your deeper tissues, and you can do this every couple hours if you have the time. Also, make sure you have a thin layer of cloth between your skin and the ice/heat pack…a

bag of frozen peas in a tea towel works great for ice. If you’re using the store-bought chemical ice bags, be careful not to leave it on too long as you may burn your skin. If, however, you are using a plastic bag with crushed ice or ice cubes, you can put it right on your skin.

When Heat is Neat

After the first 4-5 days, inflammation should be just about under control and it is safer to use heat. Keep in mind, though, if you still have swelling or significant pain, you’ll want to continue using ice and may want to think about seeing your physician if you haven’t already.

Heat is generally used for chronic injuries or conditions that have developed over a long period of time. Chronic injuries usually

present as sore, stiff, nagging pain. In these cases, heat helps reduce muscle spasm and stimulate superficial blood flow, bringing more oxygen and nutrients with it. Heat can help the tissue feel more flexible, but research shows most types of heat don’t reach the deep tissues, so if you’re looking to get bang for your buck as far as pain relief goes, apply ice to your injuries. Also, athletes with chronic injuries will often use heat before exercise to loosen joints and relax tight muscles, but an active warm up (jogging or biking) is much more effective.

Application: Heat should be applied to an injury or aching muscle for no more than 20 minutes. As with ice, never apply heat directly to your skin, and don’t lie on top of the hot pack/heating pad or you may burn yourself.

If you have any questions about your specific injury and whether or not you should ice or heat, you can ask your physician, a certified

athletic trainer, or a physical therapist. If you experience any abnormal sensations, see that your skin is turning white, or you see hives under the ice or heat, put more layers between your skin and the ice/heat or take it off completely.